People with cognitive impairment are often unable to inform others of their pain. Nurses need to be able to assess pain in cognitively impaired adults so that appropriate pain management strategies can be implemented. Evidence suggests that certain verbal, facial and behavioural signs may be indicative of pain. This article describes the process undertaken in developing a specific tool to facilitate pain assessment. The tool was developed after extensive analysis of pain research literature, input from experienced nurses and critical review by a panel of experts in dementia care. The research study will be published in next week's Nursing Standard.
Pain assessment for cognitively impaired adults should continue to be based on a combination of physiological and behavioural indicators. Assessment should be conducted as indicated by the nurse's clinical judgement and follow-up pain assessment should be undertaken after implementation of appropriate comfort measures.
This study investigated whether increasing positive mood improved interpersonal attitudes and relieved depression in depressed stroke patients despite levels of cognitive and emotional dysfunction. Depressed stroke (n = 30) and rheumatic/orthopaedic controls (n = 30) were compared on the effect of verbal and nonverbal positive and neutral mood induction on mood state, interpersonal attitudes, psychological distress and related cognitive and emotional processing deficits. Compared with the neutral mood induction condition, the positive mood induction significantly improved mood state, interpersonal attitudes and psychological distress, irrespective of cognitive and emotional processing deficits. The nonverbal material was effective for all patients but was more marked for the left hemisphere stroke group. There was no obvious influence of humour appreciation despite reduced understanding in the right hemisphere stroke group. Although the effect is likely to be short-lived, these results support the trial of positive mood induction within therapy programmes to relieve depression.
This study evaluated the psychometric properties of a simple scale for measuring positive interpersonal attitudes of depressed stroke patients, with regard to their cognitive limitations. Two versions of the Attitudes Towards Relationships Scale were developed and administered to depressed stroke (n = 48) and control rheumatic/orthopaedic (n = 45) patients during a study that investigated the relationship between mood state, interpersonal attitudes and psychological distress. Both versions produced homogeneous results and showed acceptable concurrent validity, test-retest reliability, internal consistency and measurement specificity. A principal component analysis produced a three-factor structure highlighting the importance of attitudes towards future interpersonal relationships. These results suggest that the Attitude Towards Relationships Scale may be a psychometrically sound measure that shows some potential as a therapeutic measure of progress in stroke and other comparable samples.
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